Organization
DENTAL EXPRESS MEDINA -JERRY S. KOLOSIONEK DDS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY R MAUERMAN (EXECUTIVE ADMIN)
(330) 533-3400
Entity
Organization
Contact information
Practice address
750 E WASHINGTON ST, SUITE A3, MEDINA, OH 44256-2196
(330) 725-3887
Mailing address
750 E WASHINGTON ST, SUITE A3, MEDINA, OH 44256-2196
(330) 725-3887
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
30-019480
OH
122300000X
Dentist
30-023197
OH
122300000X
Dentist
30-023233
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1143641-00-3
—
OH
Enumeration date
08/11/2010
Last updated
08/11/2010
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